Contrave-A New Weight Loss Medication

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Yesterday, December 7, 2010, the FDA approved the first new weight loss medication in several years.  Contrave is a combination of two medications already discussed in this website: naltrexone and buproprion (Wellbutrin).  
 This is a useful combination of medication that I have been using for some time.

The mechanism of action is twofold.  First, there is a direct reduction of appetite.  The increased activity of Norepinephrine cause by the buproprion does this as well as the blockade of the CART neuron opiod receptors. (see How the Brain Control Appetite)  In addition, the activity of B-endorphin is blocked in the Nucleus Accumbens, reducing the drive to overeat.

Expected side effects include irritability and sleep disturbances from the buproprion.  The naltrexone may cause nausea and has a risk of causing mild depression.  Anyone on opioid pain medication will be unable to use this. 

I have found this combination of moderate help leading to a 5-10% weight loss in about 1/3 of the people to whom it is prescribed.  It will be more effective when used in combination.

Stuart Wasser MD